Corpus overview


MeSH Disease

Human Phenotype


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    The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

    Authors: Elisa Gouvêa Bogossian; Fabio Silvio Taccone; Antonio Izzi; Nicolas Yin; Alessandra Garufi; Stephane Hublet; Hassane Nijmi; Julie Gohram; Baudoin Byl; Alexandre Brasseur; Maya Hites; Jean-Louis Vincent; Jacques Creteur; David Grimaldi

    doi:10.21203/ Date: 2020-08-28 Source: ResearchSquare

    Background: Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the  COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.Methods: This single center case control study included adult TRANS patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage HP subarachnoid hemorrhage MESHD ( SAH MESHD) and matched on length of ICU stay using a competing risk analysis.Results: Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).Conclusion: Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.

    SARS-CoV-2 and Stroke HP Stroke MESHD Characteristics: A Report from the Multinational COVID-19 Stroke HP Stroke MESHD Study Group

    Authors: Shima Shahjouei; Georgios Tsivgoulis; Rohan Arora; Mohammad Hossein Harirchian; Nasrin Rahimian; Afshin Borhani-Haghighi; Stefania Mondello; Arash Kia; Alireza Vafaei Sadr; Ashkhan Mowla; Venkatesh Avula; Saeed Ansari; Ramin Zand; Vida Abedi; Ghasem Farahmand; Eric Koza; Martin Punter; Annemarei Ranta; Achille Cernigliaro; Alaleh Vaghefi Far; Afshin Borhani-Haghighi; Jiang Li; Oluwaseyi Olulana; Durgesh Chaudhary

    doi:10.1101/2020.08.05.20169169 Date: 2020-08-07 Source: medRxiv

    Background: Stroke HP Stroke MESHD is reported as a consequence of SARS-CoV-2 infection MESHD. However, there is a lack of regarding comprehensive stroke HP stroke MESHD phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke MESHD ischemic stroke HP ( AIS MESHD), intracranial hemorrhage HP intracranial hemorrhage MESHD ( ICH MESHD), and cerebral venous or sinus thrombosis MESHD ( CVST MESHD) among SARS-CoV-2 infected MESHD patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS MESHD patients with the risk of large vessel occlusion (LVO), stroke HP stroke MESHD severity as measured by National Institute of Health stroke HP stroke MESHD scale (NIHSS), and stroke HP stroke MESHD subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke HP stroke MESHD patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke HP stroke MESHD patient. Out of 432 patients included, 323(74.8%) had AIS MESHD, 91(21.1%) ICH MESHD, and 18(4.2%) CVST MESHD. Among 23 patients with subarachnoid hemorrhage HP subarachnoid hemorrhage MESHD, 16(69.5%) had no evidence of aneurysm MESHD. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke HP stroke MESHD, 144(37.8%) presented to the hospital with chief complaints of stroke HP stroke MESHD-related symptoms, with asymptomatic TRANS or undiagnosed SARS-CoV-2 infection MESHD. Among AIS MESHD patients 44.5% had LVO; 10% had small artery occlusion MESHD according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic TRANS SARS-CoV-2 infections MESHD among stroke HP stroke MESHD patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke HP stroke MESHD severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

    Massive cerebral venous thrombosis HP cerebral venous thrombosis MESHD related to oligosymptomatic COVID-19 infection: a case report

    Authors: Simone Beretta; Fulvio Da Re; Valentina Francioni; Paolo Remida; Benedetta Storti; Lorenzo Fumagalli; Maria Luisa Piatti; Patrizia Santoro; Diletta Cereda; Claudia Cutellè; Fiammetta Pirro; Danilo Antonio Montisano; Francesca Beretta; Francesco Pasini; Annalisa Cavallero; Ildebrando Appollonio; Carlo Ferrarese

    doi:10.21203/ Date: 2020-07-27 Source: ResearchSquare

    Background: The development of thrombotic coagulopathy MESHD is frequent in COVID-19 patients, but the timing after infection, cerebral venous system involvement MESHD, treatment and outcome are uncertain.Case Presentation: We report a case of massive cerebral venous thrombosis HP cerebral venous thrombosis MESHD occurring in the late phase of COVID-19 infection MESHD. Mild respiratory symptoms, without fever HP, started three weeks before headache HP headache MESHD and acute neurological deficits MESHD. She had no dyspnea HP dyspnea MESHD, although she was hypoxic MESHD and with typical COVID-19 associated interstitial pneumonia MESHD pneumonia HP. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid haemorrhage MESHD. CT angiography showed a massive cerebral vein thrombosis MESHD. An asymptomatic TRANS concomitant right internal iliac vein thrombosis MESHD was found. Both cerebral venous thrombosis HP cerebral venous thrombosis MESHD and deep venous thrombosis HP deep venous thrombosis MESHD were effectively treated with unfractionated heparin started on the day of admission, then shifted to low molecular weight heparin, with a favorable clinical course. Nasopharyngel swab, repeated twice, tested negative for SARS-CoV-2. Serological tests SERO confirmed SARS-CoV-2 infection MESHD. Conclusions: Our case supports active surveillance and prevention of thrombotic complications MESHD associated with COVID-19, which may affect both peripheral and cerebral venous system MESHD. Early initiation of unfractionated heparin may lead to good neurological outcome.

    Aneurysmal Subarachnoid Haemorrhage MESHD After COVID-19 Infection

    Authors: Sajjad Muhammad; Soheil Naderi; Mostafa Ahmadi; Askar Ghorbani; Daniel Hänggi

    doi:10.21203/ Date: 2020-07-24 Source: ResearchSquare

    BackgroundSARS-CoV-2 virus infection leads to a severe and dysbalanced inflammatory MESHD response with hypercytokinemia and immunodepression. Systemic inflammation MESHD due to viral infections MESHD can potentially cause vascular damage MESHD including disruption of blood SERO-brain barrier (BBB) and alterations in coagulation system that may also lead to cardiovascular and neurovascular events. Here, we report the first case of COVID-19 infection MESHD leading to aneurysmal subarachnoid haemorrhage MESHD ( aSAH MESHD). Case DescriptionA 61-year-old woman presented with dyspnea HP dyspnea MESHD, cough HP cough MESHD and fever HP. She was over weight with Body mass-index of 34 and history of hypertension HP hypertension MESHD. No history of subarachnoid hemorrhage HP subarachnoid hemorrhage MESHD in the family. She was admitted in ICU due to low oxygen saturation (89%). A chest CT showed typical picture of COVID-19 pneumonia HP pneumonia MESHD. Oropharyngeal swab with a PCR-based testing was COVID-19 positive. She was prescribed with favipiravir and hydroxychloroquine in Addition to oxygen support. On second day she experienced sudden headache HP headache MESHD and losst conciousness. A computer tomography (CT) with CT-angiography revealed subarachnoid haemorrhage MESHD in basal cisterns from a ruptured anterior communicating artery aneurysm MESHD. The aneurysm MESHD was clipped microsurgically through a standard pterional approach and the patient was admitted again to intensive care unit for further intensive medical treatment. Post-operative the patient showed slight motor dysphasia HP dysphasia MESHD. No other neurological deficits.ConclusionAneurysmal subarachnoid haemorrhage MESHD secondary to COVID-19 infection MESHD might be triggered by systemic inflammation MESHD. COVID-19 infection MESHD could be one of the risk factors leading to instability and rupture of intracranial aneurysm MESHD.

    Management Protocol for Emergency Aneurysm Craniotomy Clipping MESHD in Non-Major COVID-19 Epidemic Areas in Beijing, China

    Authors: Yu Chen; Xiaolin Chen; Li Ma; Xiaofeng Deng; Zelin Li; Xun Ye; Hao Wang; Shuai Kang; Yan Zhang; Rong Wang; Dong Zhang; Yong Cao; Yuanli Zhao; Shuo Wang; Jizong Zhao

    doi:10.21203/ Date: 2020-06-05 Source: ResearchSquare

    Background: An epidemic of COVID-19 outbroke in Wuhan, China since December 2019. The ordinary medical service were hindered, however, the emergency cases including aneurysmal subarachnoid hemorrhage MESHD subarachnoid hemorrhage HP ( aSAH MESHD) still required timely intervention and provoked challenges to the management protocol. In this study, we summarized our experience in the emergency management of aSAH MESHD (Beijing Tiantan Protocol, BTP) in Beijing, China.Methods: Demographic, clinical and imaging data of consecutive emergency aSAH MESHD patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and different detail protocols. Neurological outcome was assessed with the modified Rankin Scale (mRS).Results: A total of 127 aSAH MESHD referred to our emergency department and 42 (33.1%) underwent craniotomy clipping between January 20, 2020 and March 25, 2020. Compared with the retrospective period last year, the incidence of preoperative hospitalized adverse events and postoperative outcomes were similar (0.1, 95% CI 1.0 to 0.8, P = 0.779). In the subgroup analysis, 8 (19.0%) were initially screened as preliminary undetermined COVID-19 and 2 of them underwent craniotomy clipping in the negative pressure operating room (OR), the prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission and all showed negative, the false negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (-0.3, 95% CI -1.4 to 0.9, P = 0.653).Conclusions: Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy MESHD clipping in non-major epidemic areas.

    Central Nervous System Disorders MESHD in Severe SARS-CoV-2 Infection MESHD: detailed clinical work-up of eight cases

    Authors: Emanuela Keller; Giovanna Brandi; Sebastian Winklhofer; Lukas Imbach; Daniel Kirschenbaum; Karl Joachim Frontzek; Peter Steiger; Sabeth Aurelia Dietler; Marcellina Isabelle Haeberlin; Jan Folkard Willms; Francesca Porta; Adrian Waeckerlin; Irene Alma Abela; Andreas Lutterotti; Christoph Stippich; Ilijas Jelcic

    doi:10.21203/ Date: 2020-05-29 Source: ResearchSquare

    Objective Case series with different clinical presentations indicating central nervous system (CNS) involvement in coronavirus disease MESHD 2019 (COVID-19) have been published. Comprehensive work-ups including clinical characteristics, laboratory, electroencephalography (EEG), neuroimaging and cerebrospinal fluid (CSF) findings are needed to understand the mechanisms.DesignWe evaluated 32 consecutive patients with severe SARS-CoV-2 infection MESHD treated at a tertiary care centre from March 09 to April 03, 2020 for concomitant severe central nervous system (CNS) symptoms occurring during their critical disease state. Those with CNS disorders MESHD were examined in detail regarding clinical characteristics and undergoing additional examinations, e.g. computed tomography (CT), magnetic resonance imaging (MRI), (EEG), (CSF) analysis and autopsy if they had died.ResultsOf 32 critically ill patients with COVID-19 eight (18%) had severe CNS involvement (mean [SD] age TRANS, 67.6 [6.8] years; seven men; two patients died). All eight patients had cardiovascular risk factors, most frequently arterial hypertension HP hypertension MESHD. Two patients presented with lacunar ischemic stroke HP ischemic stroke MESHD and one with status epilepticus HP status epilepticus MESHD in the early phase. As most common presentation, six patients presented with prolonged impaired consciousness MESHD after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in three of them with additional subarachnoid haemorrhage MESHD and in another two with additional small ischemic lesions MESHD. In three patients intracranial vessel wall sequence MRI was performed, for the first time to our knowledge. All cases showed contrast-enhancement of vessel walls in large and middle-sized cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. CSF analysis showed normal cells counts and chemistry. RT-PCRs for SARS-CoV-2 in CSF were all negative, and no intrathecal SARS-CoV-2 specific IgG synthesis was detectable. ConclusionsCNS disorders MESHD are common in patients with severe COVID-19. Different mechanisms might be involved. Besides unspecific encephalopathy HP encephalopathy MESHD and encephalitic syndromes MESHD, large vessel strokes HP strokes MESHD might occur early after disease onset. In a later phase, microbleeds and microinfarctions indicate potential CNS small vessel disease. MRI vessel wall contrast enhancement suggests cerebral vascular wall pathologies with an inflammatory component. CNS disorders MESHD associated with COVID-19 may lead to long-term disabilities aggravating socio-economic damage. The mechanisms have to be investigated urgently in order to develop preventive and therapeutic neuroprotective strategies.

    COVID-19 Utilization and Resource Visualization Engine (CURVE) to Forecast In-Hospital Resources

    Authors: Shih-Hsiung Chou; James T. Kearns; Philip Turk; Marc Kowalkowski; Jason Roberge; Jennifer S. Priem; Yhenneko J Taylor; Ryan Burns; Pooja Palmer; Andrew D. McWilliams

    doi:10.1101/2020.05.01.20087973 Date: 2020-05-06 Source: medRxiv

    Background: The emergence of COVID-19 has created an urgent threat to public health worldwide. With rapidly evolving demands on healthcare resources, it is imperative that healthcare systems have the ability to access real-time local data to predict, plan, and effectively manage resources. Objective: To develop an interactive COVID-19 Utilization and Resource Visualization Engine (CURVE) as a data visualization tool to inform decision making and guide a large health system's proactive pandemic response. Methods: We designed and implemented CURVE using R Shiny to display real-time parameters of healthcare utilization at Atrium Health with projections based upon locally derived models for the COVID-19 pandemic. We used the CURVE app to compare predictions from two of our models: one created before and one after the statewide stay-at-home and social distancing orders (denoted before- and after- SAH MESHD-order model). We established parameter settings for best-, moderate-, and worst-case scenarios for pandemic spread and resource use, leveraging two locally developed forecasting models to determine peak date trajectory, resource use, and root mean square error MESHD ( RMSE MESHD) between observed and predicted results. Results: CURVE predicts and monitors utilization of hospital beds, ICU beds, and number of ventilators in the context of up-to-date local resources and provides Atrium Health leadership with timely, actionable insights to guide decision-making during the COVID-19 pandemic. The after- SAH MESHD-order model demonstrated the lowest RMSE MESHD in total bed, ICU bed, and patients on ventilators. Conclusions: CURVE provides a powerful, interactive interface that provides locally relevant, dynamic, timely information to guide health system decision making and pandemic preparedness.

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MeSH Disease
Human Phenotype

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